This document discusses the Expanded Program on Immunization (EPI) established by the World Health Organization in 1974. It aims to increase immunization coverage for children through standardizing schedules, promoting safe injection practices, ensuring vaccine availability, and maintaining cold chains. The EPI focuses on eliminating or reducing diseases like polio, measles, hepatitis B, neonatal tetanus, diphtheria, tuberculosis, pertussis, and pneumonia. It also discusses naturally acquired and artificial immunity, different vaccine types including live attenuated, inactivated, toxoid, subunit and conjugate vaccines, and their administration schedules and potential reactions.

1. .
MBBS. DPH, Dip-Card, M.Phil, FCPS
Assistant Professor Community Medicine
Services Institute Of Medical Sciences Lahore
The Expanded Program
On Immunization
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3. Immunization is the a process where by a
person is made immune or resistant to an
infection, typically by administration of
vaccines
Immunization is a proven tool for controlling
and elimination life-threatening infectious
disease .
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4. The Expanded Programme on Immunization
(EPI) was established in 1974 through a World
Health Assembly resolution to build on the
success of the global smallpox eradication
programme, and to ensure that all children in
all countries benefited from life-saving
vaccines
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5.  Objectives
The expanded immunization program, the who's
initiative to improve immunization coverage,
focuses on the following four items:
 Standardizing immunization schedules
 Promoting safe injection technologies
 Improving the stocking and availability of vaccines
 Protecting vaccines' potency through cold chain
management

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6. 1. To increase coverage of immunization for eligible
children.
2. To reduce the incidence of immunizable
diseases among children below five years of
age.
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7. Eradication of polio to maintain polio free
status.
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8. Elimination of measles.
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9. Reduce Incidence of
hepatitis B
among under five.
HBV
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10. Elimination of Neonatal Tetanus .
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11. Maintain zero level of diphtheria.
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12. Prevention of severe forms of TB ( TB meningitis
&military TB).
12 year old girl with TB meningitis
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13. reduce the incidence of whooping cough
.
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15. 3. Promoting safe injection techniques
4. Improve the stocking and availability of vaccines
5.Protecting vaccine potency through cold chain management
6.To prepare for introduction of new vaccines
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16. The immune system
Immunity: Ability of an organism to recognize and
defend itself against specific pathogens or
antigens.
Immune Response: Involves production of
antibodies and generation of specialized
lymphocytes against specific antigens.
Antigen: Molecules from a pathogen or foreign
organism that provoke a specific immune
response.
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17. Types of Immunity:-
 Innate or natural Immunity:
 Immunity an organism is born with.
 Acquired Immunity:
Immunity that an organism develops during
lifetime.
May be acquired naturally or artificially.
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19. Types of Acquired Immunity
I. Naturally Acquired Immunity: Obtained in the
course of daily life.
Two types:-
A. Naturally Acquired Active Immunity:
Antigens or pathogens enter body naturally.
Body generates an immune response to antigens.
.
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20. Types of Acquired Immunity
B. Naturally Acquired Passive Immunity:
Antibodies pass from mother to fetus via placenta or breast
feeding .
No immune response to antigens.
Immunity is usually short-lived (weeks to months).
Protection until child’s immune system develops.
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21. Types of Acquired Immunity (Continued)
II. Artificially Acquired Immunity: Obtained by
receiving a vaccine or antibodies.
1. Artificially Acquired Active Immunity:
Antigens are introduced in vaccines (immunization).
Body generates an immune response to antigens.
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22. Types of Acquired Immunity (Continued)
.
2. Artificially Acquired Passive Immunity:
Antibodies are introduced into body by injection.
Snake antivenom injection from horses or rabbits.
Immunity is short lived (half life three weeks).
Host immune system does not respond to antigens.
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25.  A vaccine is a non-pathogenic antigen that
mimics a particular pathogen in order to elicit
an immune response as if that actual
pathogen were in the body.
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26. 1. Live, Attenuated Vaccines
-Viral such as measles, mumps, rubella, oral
polio and rota virus
-Bacterial such as BCG
2. Inactivated Vaccines
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27. 2. Inactivated Vaccines
A. Whole cell vaccine
-Viral
-Bacterial
B. Fractional
1-Protein based
Toxoid
Subunit
2-Polysaccharide based
Pure
conjugate
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28. 2. Inactivated Vaccines
A. Whole cell vaccine
-Viral such as Hepatitis A, polio and rabies
-Bacterial such as Pertussis
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29. 2. Inactivated Vaccines
A. Whole cell vaccine
-Viral
-Bacterial
B. Fractional
1-Protein based
Toxoid such as diphtheria, tetanus
Subunit such as hepatitis B
2-Polysaccharide based
Pure such as pneumococcal and meningococcal
vaccines
conjugate such as Haemophilus influenzae type B
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30. Inactivated
Vaccines
Attenuated
vaccine
HighLowVaccine dose
ShortLongAntibody
persistence
FrequentlyInfrequentlyBooster needed
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31. 1. Live, Attenuated Vaccines
Live, attenuated vaccines contain a version of the
living microbe that has been weakened in the
lab so it can’t cause disease.
They elicit strong immune system response and
often confer lifelong immunity with only one or
two doses.
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32. Live, Attenuated Vaccines
 live, attenuated vaccines usually need to be
refrigerated to stay potent.
 Live, attenuated vaccines are relatively easy to create for
certain viruses. Viruses are simple microbes containing
a small number of genes,
 Live, attenuated vaccines are more difficult to create for
bacteria. Bacteria have thousands of genes and thus are
much harder to
 people who have damaged or weakened immune
systems, such as people who undergone chemotherapy
or have HIV, can not be given live vaccines..
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33. Inactivated Vaccines
 Scientists produce inactivated vaccines by
killing the disease-causing microbe with
chemicals, heat, or radiation.
 Inactivated vaccines usually don’t require
refrigeration, and they can be easily stored
and transported in a freeze-dried form,
which makes them accessible to people in
developing countries.
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34. Inactivated Vaccines
 Most inactivated vaccines, however,
stimulate a weaker immune system
response than do live vaccines.
 So it would likely take several additional
doses, or booster shots, to maintain a
person’s immunity.
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35. Protein based
Subunit Vaccines
Instead of the entire microbe, subunit vaccines
include only the antigens that best stimulate
the immune system.
This make the chances of adverse reactions to
the vaccine are lower. .
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36. subunit vaccines can be made in one of two
ways:
1. They can grow the microbe in the laboratory and then
use chemicals to break it apart and gather the
important antigens.
2.They can manufacture the antigen molecules from the
microbe using recombinant DNA technology.
Vaccines produced this way are called “recombinant
subunit vaccines.” such as hepatitis B virus vaccine..
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37. Scientists inserted hepatitis B genes that code
for important antigens into common baker’s
yeast. The yeast then produced the antigens,
which the scientists collected use in the
vaccine
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38. Protein based Vaccines
Toxoid Vaccines
These vaccines are used when a bacterial
toxin is the main cause of illness.
Toxins are inactivate by treating them with
formalin.
Vaccines against diphtheria and tetanus are
examples of toxoid vaccines.
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39. Pure polysaccharides. Vaccines
Some bacterium possess an outer coating of sugar
molecules called polysaccharides.
vaccine is made up of long chain of sugar molecules
infant’s immune system can not recognize to the
polysaccharides.
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40. Conjugate Vaccines
Some bacterium possess an outer coating of sugar
molecules called polysaccharides.
When making a conjugate vaccine, scientists link antigens
or toxoids from a microbe that an infant’s immune
system can recognize to the polysaccharides.
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41. •The vaccine that protects against Haemophilus
influenzae type B (Hib) is a conjugate vaccine.
•It is made by joining a piece of the polysaccharide
capsule that surrounds the Hib bacterium to a protein
carrier.
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42. Vaccine SCHEDULE
BCG At birth
OPV0 At birth
Pentavalente 1
(DPT + HB + H),OPV1
6 weeks
, Pentavalente
DPT + HB + Hib) ,OPV2
10 weeks
Pentavalente
(DPT + HB + Hib),OPV3
14 weeks
Measles Nine month
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44. DOSE SCHEDULE
TT1 Any time at first contact or as
early as possible during
pregnancy
TT2 One month after the first
visit(TT1)
TT3 Six months after TT2 or during
subsequent pregnancy
TT4 One year after TT3or during
subsequent pregnancy
TT5 One year after TT4or during
subsequent pregnancy
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45. Diseases Type of vaccine Dose Rout of administration
1-BCG
2-HBV
TB
Hepatitis B
Live attenuated,
variant
Recombinant, yeast
derived HBs antigen
0.05ml
0.5 ml
ID injection in left
forearm
IM thigh
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46. Rout of
administration
DoseType of vaccineDiseases
oral2 dropsLive attenuatedPolio3-OPV
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47. Rout of
administration
DoseType of vaccineDiseases
IM thigh0.5 mlpolysaccharide
conjugate
Hib diseaseHiB
Recombinant, yeast
derived HBs antigen
Hepatitis BHBV
Toxoid (D)
Toxoid (T)
Killed pertussis (P)
Diphtheria
Tetanus
Whooping
cough
DPT
Pentavalent Vaccine
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48. Mode of
administrationDose
Type of the
vaccine
The
disease
Subcutaneous0.5 mlLive attenuatedMeasles
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49. BCG (At birth)
•Live attenuated variant.
•0.05ml .
•ID injection in left forearm
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52. local reactions:
swelling, redness, or pain at the injection site.
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